This document discusses various types of speech abnormalities that can occur due to neurological disorders or injuries. It describes the differences between aphasia, which is a language disorder, and dysarthria, which is a motor speech disorder affecting articulation. Dysarthria can be caused by lesions or weaknesses in different areas including the nerves, muscles or brain areas involved in speech production. Specific types of dysarthria like ataxic, spastic or flaccid are described. Other conditions mentioned include stuttering, spasmodic dysphonia and the speech effects of disorders like ALS, Parkinson's disease or stroke.
This document discusses speech disorders and their classification. It covers the anatomy and physiology of speech production, different types of speech disorders like aphasia and dysarthria, and their causes and management. Aphasia refers to language impairment due to brain damage and can cause deficits in speaking, comprehension, reading and writing. Dysarthria is defective articulation due to neurological problems, while language functions remain intact. Speech disorders are classified as disorders of language like aphasia or disorders of articulation/voice production.
This document provides an overview of speech therapy and communication disorders. It discusses that communication involves the exchange of information verbally and non-verbally. Speech disorders are classified as aphasia, dysarthria, or dysphonia. Aphasia is caused by brain damage and impairs language comprehension and use. Types of aphasia include Broca's, Wernicke's, and conduction aphasia. Dysarthria refers to motor speech defects from trauma or disease that affect articulation, loudness, and other speech aspects. Speech therapy treats conditions like cleft palate, cerebral palsy, autism, and Bell's palsy through techniques like imitation, repetition, listening, and sign
Speech defect is a type of communication disorder that disrupts normal speech. Speech therapy is a rehabilitative procedure to help people with communication or swallowing problems. Speech defects are classified based on the sounds a patient can produce, whether sounds need demonstration to be stimulated, and sounds that cannot be produced. Major types include aphasia, dysarthria, dysphonia, cluttering, stammering, and apraxia. Diagnostic evaluations include history, physical exams of the head and neck, and tests like laryngoscopy. Management involves correcting underlying conditions, special education, and speech therapy techniques like remediation, language exercises, and swallowing therapy.
Dysarthria refers to difficulty articulating speech muscles and sounds. There are several types of dysarthria based on the underlying cause, including spastic dysarthria from diseases affecting motor pathways like ALS, rigid dysarthria from extrapyramidal lesions causing facial rigidity as in Parkinson's, and ataxic dysarthria from incoordination of speech muscles in conditions like multiple sclerosis. Specific muscles affected results in slurring of certain sounds or letters, and the speech may be irregular, slurred, too loud or soft. Myasthenic dysarthria causes weakening of voice as sentences progress.
Communication disorders with it's implications and it's management
Defined communication processes.
Have any doubt any lacking please drop in comment box
Pyscholinguistics what are speech language disordersDeysiChipantiza
This document provides descriptions of various speech, language, and communication disorders. It discusses disorders that can affect the ability to express or understand language like aphasia, which is an impairment of language caused by brain injury. It also describes disorders like dysarthria that affect speech production, as well as disorders involving the structures of the mouth like cleft lip and palate. Additionally, it outlines communication disorders and therapies, including those that require augmentative aids, voice therapies, and accent modification training.
Language disorders involve problems processing linguistic information that can affect grammar, semantics, and other aspects of language. They can be receptive, involving comprehension issues, expressive, involving production problems, or both. Common language disorders include specific language impairment and aphasia. The document goes on to describe receptive language disorders which impact understanding language inputs, expressive disorders affecting output of language, speech disorders, communication disorders, and several specific types of language disorders like dyslexia, dysgraphia, and their symptoms.
The document describes various normal anatomical structures and abnormalities that can present on the tongue, including different types of papillae, taste buds, and developmental variations. It then discusses many potential clinical findings involving the tongue related to deficiencies, infections, tumors, and other oral diseases. Specific conditions covered in detail include hairy tongue, leukoplakia, geographic tongue, candidiasis, macroglossia, ulcers, deviations and ties. Multiple images are also provided to illustrate key pathologies.
This document discusses speech disorders and their classification. It covers the anatomy and physiology of speech production, different types of speech disorders like aphasia and dysarthria, and their causes and management. Aphasia refers to language impairment due to brain damage and can cause deficits in speaking, comprehension, reading and writing. Dysarthria is defective articulation due to neurological problems, while language functions remain intact. Speech disorders are classified as disorders of language like aphasia or disorders of articulation/voice production.
This document provides an overview of speech therapy and communication disorders. It discusses that communication involves the exchange of information verbally and non-verbally. Speech disorders are classified as aphasia, dysarthria, or dysphonia. Aphasia is caused by brain damage and impairs language comprehension and use. Types of aphasia include Broca's, Wernicke's, and conduction aphasia. Dysarthria refers to motor speech defects from trauma or disease that affect articulation, loudness, and other speech aspects. Speech therapy treats conditions like cleft palate, cerebral palsy, autism, and Bell's palsy through techniques like imitation, repetition, listening, and sign
Speech defect is a type of communication disorder that disrupts normal speech. Speech therapy is a rehabilitative procedure to help people with communication or swallowing problems. Speech defects are classified based on the sounds a patient can produce, whether sounds need demonstration to be stimulated, and sounds that cannot be produced. Major types include aphasia, dysarthria, dysphonia, cluttering, stammering, and apraxia. Diagnostic evaluations include history, physical exams of the head and neck, and tests like laryngoscopy. Management involves correcting underlying conditions, special education, and speech therapy techniques like remediation, language exercises, and swallowing therapy.
Dysarthria refers to difficulty articulating speech muscles and sounds. There are several types of dysarthria based on the underlying cause, including spastic dysarthria from diseases affecting motor pathways like ALS, rigid dysarthria from extrapyramidal lesions causing facial rigidity as in Parkinson's, and ataxic dysarthria from incoordination of speech muscles in conditions like multiple sclerosis. Specific muscles affected results in slurring of certain sounds or letters, and the speech may be irregular, slurred, too loud or soft. Myasthenic dysarthria causes weakening of voice as sentences progress.
Communication disorders with it's implications and it's management
Defined communication processes.
Have any doubt any lacking please drop in comment box
Pyscholinguistics what are speech language disordersDeysiChipantiza
This document provides descriptions of various speech, language, and communication disorders. It discusses disorders that can affect the ability to express or understand language like aphasia, which is an impairment of language caused by brain injury. It also describes disorders like dysarthria that affect speech production, as well as disorders involving the structures of the mouth like cleft lip and palate. Additionally, it outlines communication disorders and therapies, including those that require augmentative aids, voice therapies, and accent modification training.
Language disorders involve problems processing linguistic information that can affect grammar, semantics, and other aspects of language. They can be receptive, involving comprehension issues, expressive, involving production problems, or both. Common language disorders include specific language impairment and aphasia. The document goes on to describe receptive language disorders which impact understanding language inputs, expressive disorders affecting output of language, speech disorders, communication disorders, and several specific types of language disorders like dyslexia, dysgraphia, and their symptoms.
The document describes various normal anatomical structures and abnormalities that can present on the tongue, including different types of papillae, taste buds, and developmental variations. It then discusses many potential clinical findings involving the tongue related to deficiencies, infections, tumors, and other oral diseases. Specific conditions covered in detail include hairy tongue, leukoplakia, geographic tongue, candidiasis, macroglossia, ulcers, deviations and ties. Multiple images are also provided to illustrate key pathologies.
This document defines and classifies different types of speech disorders, including stuttering, cluttering, dysprosody, muteness, articulation disorders, phonemic disorders, voice disorders, dysarthria, and apraxia. It lists various causes of speech disorders such as hearing loss, neurological disorders, brain injury, and physical impairments. Speech therapy is identified as the primary treatment, with the speech language pathologist using language intervention activities, articulation exercises, and oral-motor exercises to help patients improve their speech.
Communication is a fundamental aspect of human interaction. It allows us to express our thoughts, emotions, and desires. However, for some individuals, communication can become a challenge due to a condition known as aphasia. Aphasia is a neurological disorder that affects language abilities, making it difficult to understand and express language effectively. In this blog post, we will delve into the world of aphasia, exploring its causes, types, and the impact it has on individuals and their loved ones.
The tongue is a muscular organ located partially in the oral cavity and oropharynx that has several parts including the root, tip, and body and serves functions like taste perception, speech, chewing, and swallowing. It receives nerves from various cranial nerves that provide sensation like touch, temperature, and taste. The document also discusses common tongue disorders, blood supply, and some anatomical details of the different parts of the tongue.
The document provides information about the anatomy of the tongue and palate. It discusses the embryology, functions, muscles, blood supply, innervation and clinical considerations of the tongue. It also discusses the anatomy of the hard palate, soft palate, muscles and blood supply of the palate. Finally, it summarizes the three phases of deglutition - the oral, pharyngeal and esophageal phases.
This document provides an overview of aphasia and related language disorders. It defines aphasia as an acquired disorder of language ability caused by brain damage, distinguishing it from developmental disorders. The document outlines the neurological bases of language in the brain and describes different types of aphasia syndromes caused by lesions in various language areas, including Broca's aphasia, characterized by non-fluent speech with omission of grammatical words. Evaluation methods including analysis of spontaneous speech, naming, repetition, reading, and writing are also summarized.
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.
Common speech disorders are:
1. Articulation disorders
2. Phonological disorders
3. Disfluency
4. Voice disorders or resonance disorders
The document discusses the relationship between language and the brain. It describes how the field of study began in the 19th century based on the case of Phineas Gage who suffered a brain injury but survived with his language abilities intact, showing language is not situated at the front of the brain. It then discusses Broca's and Wernicke's areas of the brain and their roles in speech production and comprehension. Additional topics covered include tip of the tongue phenomenon, slips of the tongue, aphasia, dichotic listening tests, and the critical period for language development.
Speech is the process of producing specific sounds that convey meaning to
the listener. A speech disorder refers to any condition that affects a
person’s ability to produce sounds that create words.
Speech is one of the main ways in which people communicate their
thoughts, feelings, and ideas with others. The act of speaking requires the
precise coordination of multiple body parts, including the head, neck , chest,
and abdomen .
Speech disorders can affect the way a person creates sounds to form
words. Certain voice disorders may also be considered speech disorde
In this slide all other information also mention like type of the speech difficulty and their sign and symptoms and also explained the treatment or promotion of normal speech
Aphasia is an acquired communication disorder that impairs a person's ability to process language. It can cause problems with speaking, listening, reading, and writing. The type and severity of aphasia depends on the location of brain damage, usually in the left hemisphere. Broca's aphasia involves non-fluent speech and impaired comprehension of syntax. Wernicke's aphasia features fluent but meaningless speech and impaired comprehension. Global aphasia combines deficits of both Broca's and Wernicke's aphasia.
This document provides a classification and overview of various disorders that can affect the tongue. It discusses inherited/congenital disorders like partial ankyloglossia, variations in tongue movement, and macroglossia. It also covers diseases of the lingual mucosa such as geographic tongue and hairy tongue. Finally, it summarizes disorders that affect the body of the tongue and tumors that can develop on the tongue.
The document discusses language processing in the brain. It describes key language areas like Broca's area and Wernicke's area and their functions. It also covers topics like aphasia, which is a disturbance in language comprehension or production caused by brain damage. Dichotic listening tests and the concept of a critical period in language acquisition are also summarized.
Communication problem & its management.Srinivas Nayak
what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach
Language disorders involve problems processing linguistic information and can affect grammar, semantics, and other aspects of language. They can be receptive, involving comprehension, expressive, involving production, or both. Common examples are specific language impairment and aphasia. Receptive language disorders impair understanding of input while expressive disorders affect output. Symptoms vary but can include difficulties with sentences, vocabulary, instructions, and frustration. Other types of language disorders discussed are sensory impairments, apraxia, dyslexia, dysgraphia, stuttering, autism, and ADHD.
This document discusses speech and language disorders, including their symptoms, causes, diagnosis, and treatment. Speech disorders can affect fluency, articulation, or voice, while language disorders involve receptive or expressive difficulties. Children may develop these disorders due to brain conditions, while adults can due to events like stroke. Diagnosis is made by a speech pathologist, and treatment may involve therapy, addressing underlying causes, or assistive devices.
This document provides an overview of the anatomy and clinical considerations of the tongue. It discusses the embryology, external features, muscles, blood supply, nerve supply, development anomalies, and applications of tongue flaps in reconstructive surgery. The tongue is made of skeletal muscles and connective tissue supplied by branches of the lingual artery and innervated by the hypoglossal nerve. Common developmental anomalies include ankyloglossia, macroglossia, and bifid tongue. Tongue flaps are useful in reconstructing defects in the oral cavity due to the tongue's rich blood supply and low donor site morbidity.
This document discusses various conditions that can hinder learning, including attention deficit hyperactivity disorder (ADHD), dyslexia, dysgraphia, cluttering, stuttering, lisps, and color blindness. It provides details on the symptoms, characteristics, subtypes and classifications of each condition.
- Aphasia is an acquired communication disorder that impairs language processing but not intelligence. It can affect speaking, comprehension, reading and writing.
- The brain has specialized language modules that can be impaired by damage to areas like Broca's area in the frontal lobe, affecting expressive language abilities.
- Treatment strategies include impairment-based therapies to repair language skills, compensatory strategies using alternative communication methods, and participation-based therapies engaging family/social support networks.
This document provides an overview of aphasia and aphasia syndromes. It defines aphasia as an acquired language disorder resulting from brain damage. The major aphasia syndromes discussed are Broca's aphasia (nonfluent speech with relatively preserved comprehension), Wernicke's aphasia (fluent but meaningless speech with impaired comprehension), global aphasia (combination of Broca's and Wernicke's deficits), conduction aphasia (impaired repetition with otherwise intact language), and pure word deafness (isolated auditory comprehension deficit). Each syndrome is characterized by its pattern of impaired and preserved language functions as well as its associated neurological deficits and lesion location.
This document summarizes the physiology of language and speech. It discusses that key brain areas like Broca's area and Wernicke's area are involved in language production and comprehension. Broca's area processes information from Wernicke's area for vocalization, while Wernicke's area is involved in comprehension. Damage to different areas can cause different types of aphasias - nonfluent aphasia results from Broca's area damage and causes slow, effortful speech, while fluent aphasia from Wernicke's area damage causes meaningless but fluent speech. Conduction aphasia results from damage to the connection between these areas.
This document discusses cerebral swelling and edema that can occur after traumatic brain injury (TBI). It describes two main types of edema - vasogenic edema caused by blood-brain barrier disruption and cytotoxic edema caused by osmolar and cellular changes. Excitotoxicity from excessive glutamate release can also contribute to edema and neuronal injury through sodium and calcium-dependent mechanisms. Both necrosis and apoptosis can result from secondary injury processes. Animal studies show developing neurons are more susceptible to excitotoxic injury. Various spinal cord injury syndromes are also summarized.
- Neuromuscular junction disorders involve impaired neurotransmission between nerves and muscles. The three most common are myasthenia gravis, Lambert-Eaton myasthenic syndrome, and botulism.
- Electrodiagnostic testing is important for diagnosis. Repetitive nerve stimulation can show a decrement over 10% with slow stimulation in myasthenia gravis. Exercise may cause a post-exercise increment in Lambert-Eaton.
- Single fiber EMG is the most sensitive test, looking for increased jitter between motor unit action potentials. Together with history and exam, electrodiagnostics help differentiate the three main NMJ disorders.
This document defines and classifies different types of speech disorders, including stuttering, cluttering, dysprosody, muteness, articulation disorders, phonemic disorders, voice disorders, dysarthria, and apraxia. It lists various causes of speech disorders such as hearing loss, neurological disorders, brain injury, and physical impairments. Speech therapy is identified as the primary treatment, with the speech language pathologist using language intervention activities, articulation exercises, and oral-motor exercises to help patients improve their speech.
Communication is a fundamental aspect of human interaction. It allows us to express our thoughts, emotions, and desires. However, for some individuals, communication can become a challenge due to a condition known as aphasia. Aphasia is a neurological disorder that affects language abilities, making it difficult to understand and express language effectively. In this blog post, we will delve into the world of aphasia, exploring its causes, types, and the impact it has on individuals and their loved ones.
The tongue is a muscular organ located partially in the oral cavity and oropharynx that has several parts including the root, tip, and body and serves functions like taste perception, speech, chewing, and swallowing. It receives nerves from various cranial nerves that provide sensation like touch, temperature, and taste. The document also discusses common tongue disorders, blood supply, and some anatomical details of the different parts of the tongue.
The document provides information about the anatomy of the tongue and palate. It discusses the embryology, functions, muscles, blood supply, innervation and clinical considerations of the tongue. It also discusses the anatomy of the hard palate, soft palate, muscles and blood supply of the palate. Finally, it summarizes the three phases of deglutition - the oral, pharyngeal and esophageal phases.
This document provides an overview of aphasia and related language disorders. It defines aphasia as an acquired disorder of language ability caused by brain damage, distinguishing it from developmental disorders. The document outlines the neurological bases of language in the brain and describes different types of aphasia syndromes caused by lesions in various language areas, including Broca's aphasia, characterized by non-fluent speech with omission of grammatical words. Evaluation methods including analysis of spontaneous speech, naming, repetition, reading, and writing are also summarized.
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.
Common speech disorders are:
1. Articulation disorders
2. Phonological disorders
3. Disfluency
4. Voice disorders or resonance disorders
The document discusses the relationship between language and the brain. It describes how the field of study began in the 19th century based on the case of Phineas Gage who suffered a brain injury but survived with his language abilities intact, showing language is not situated at the front of the brain. It then discusses Broca's and Wernicke's areas of the brain and their roles in speech production and comprehension. Additional topics covered include tip of the tongue phenomenon, slips of the tongue, aphasia, dichotic listening tests, and the critical period for language development.
Speech is the process of producing specific sounds that convey meaning to
the listener. A speech disorder refers to any condition that affects a
person’s ability to produce sounds that create words.
Speech is one of the main ways in which people communicate their
thoughts, feelings, and ideas with others. The act of speaking requires the
precise coordination of multiple body parts, including the head, neck , chest,
and abdomen .
Speech disorders can affect the way a person creates sounds to form
words. Certain voice disorders may also be considered speech disorde
In this slide all other information also mention like type of the speech difficulty and their sign and symptoms and also explained the treatment or promotion of normal speech
Aphasia is an acquired communication disorder that impairs a person's ability to process language. It can cause problems with speaking, listening, reading, and writing. The type and severity of aphasia depends on the location of brain damage, usually in the left hemisphere. Broca's aphasia involves non-fluent speech and impaired comprehension of syntax. Wernicke's aphasia features fluent but meaningless speech and impaired comprehension. Global aphasia combines deficits of both Broca's and Wernicke's aphasia.
This document provides a classification and overview of various disorders that can affect the tongue. It discusses inherited/congenital disorders like partial ankyloglossia, variations in tongue movement, and macroglossia. It also covers diseases of the lingual mucosa such as geographic tongue and hairy tongue. Finally, it summarizes disorders that affect the body of the tongue and tumors that can develop on the tongue.
The document discusses language processing in the brain. It describes key language areas like Broca's area and Wernicke's area and their functions. It also covers topics like aphasia, which is a disturbance in language comprehension or production caused by brain damage. Dichotic listening tests and the concept of a critical period in language acquisition are also summarized.
Communication problem & its management.Srinivas Nayak
what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach
Language disorders involve problems processing linguistic information and can affect grammar, semantics, and other aspects of language. They can be receptive, involving comprehension, expressive, involving production, or both. Common examples are specific language impairment and aphasia. Receptive language disorders impair understanding of input while expressive disorders affect output. Symptoms vary but can include difficulties with sentences, vocabulary, instructions, and frustration. Other types of language disorders discussed are sensory impairments, apraxia, dyslexia, dysgraphia, stuttering, autism, and ADHD.
This document discusses speech and language disorders, including their symptoms, causes, diagnosis, and treatment. Speech disorders can affect fluency, articulation, or voice, while language disorders involve receptive or expressive difficulties. Children may develop these disorders due to brain conditions, while adults can due to events like stroke. Diagnosis is made by a speech pathologist, and treatment may involve therapy, addressing underlying causes, or assistive devices.
This document provides an overview of the anatomy and clinical considerations of the tongue. It discusses the embryology, external features, muscles, blood supply, nerve supply, development anomalies, and applications of tongue flaps in reconstructive surgery. The tongue is made of skeletal muscles and connective tissue supplied by branches of the lingual artery and innervated by the hypoglossal nerve. Common developmental anomalies include ankyloglossia, macroglossia, and bifid tongue. Tongue flaps are useful in reconstructing defects in the oral cavity due to the tongue's rich blood supply and low donor site morbidity.
This document discusses various conditions that can hinder learning, including attention deficit hyperactivity disorder (ADHD), dyslexia, dysgraphia, cluttering, stuttering, lisps, and color blindness. It provides details on the symptoms, characteristics, subtypes and classifications of each condition.
- Aphasia is an acquired communication disorder that impairs language processing but not intelligence. It can affect speaking, comprehension, reading and writing.
- The brain has specialized language modules that can be impaired by damage to areas like Broca's area in the frontal lobe, affecting expressive language abilities.
- Treatment strategies include impairment-based therapies to repair language skills, compensatory strategies using alternative communication methods, and participation-based therapies engaging family/social support networks.
This document provides an overview of aphasia and aphasia syndromes. It defines aphasia as an acquired language disorder resulting from brain damage. The major aphasia syndromes discussed are Broca's aphasia (nonfluent speech with relatively preserved comprehension), Wernicke's aphasia (fluent but meaningless speech with impaired comprehension), global aphasia (combination of Broca's and Wernicke's deficits), conduction aphasia (impaired repetition with otherwise intact language), and pure word deafness (isolated auditory comprehension deficit). Each syndrome is characterized by its pattern of impaired and preserved language functions as well as its associated neurological deficits and lesion location.
This document summarizes the physiology of language and speech. It discusses that key brain areas like Broca's area and Wernicke's area are involved in language production and comprehension. Broca's area processes information from Wernicke's area for vocalization, while Wernicke's area is involved in comprehension. Damage to different areas can cause different types of aphasias - nonfluent aphasia results from Broca's area damage and causes slow, effortful speech, while fluent aphasia from Wernicke's area damage causes meaningless but fluent speech. Conduction aphasia results from damage to the connection between these areas.
This document discusses cerebral swelling and edema that can occur after traumatic brain injury (TBI). It describes two main types of edema - vasogenic edema caused by blood-brain barrier disruption and cytotoxic edema caused by osmolar and cellular changes. Excitotoxicity from excessive glutamate release can also contribute to edema and neuronal injury through sodium and calcium-dependent mechanisms. Both necrosis and apoptosis can result from secondary injury processes. Animal studies show developing neurons are more susceptible to excitotoxic injury. Various spinal cord injury syndromes are also summarized.
- Neuromuscular junction disorders involve impaired neurotransmission between nerves and muscles. The three most common are myasthenia gravis, Lambert-Eaton myasthenic syndrome, and botulism.
- Electrodiagnostic testing is important for diagnosis. Repetitive nerve stimulation can show a decrement over 10% with slow stimulation in myasthenia gravis. Exercise may cause a post-exercise increment in Lambert-Eaton.
- Single fiber EMG is the most sensitive test, looking for increased jitter between motor unit action potentials. Together with history and exam, electrodiagnostics help differentiate the three main NMJ disorders.
Hypoglycemic encephalopathy occurs when low blood glucose levels affect brain function, potentially causing confusion, seizures, and coma. Prolonged severe hypoglycemia below 30 mg/dL can cause irreversible brain injury if glucose is not administered immediately. Common causes include insulin overdose, insulin-secreting tumors, liver failure, and rare genetic disorders. Symptoms progress from confusion and seizures to deep coma if blood glucose drops below 10 mg/dL. Treatment involves quickly correcting low blood glucose to prevent permanent brain damage, especially in vulnerable areas like the basal ganglia, cortex, substantia nigra, and hippocampus.
This document discusses dizziness, vertigo, and hearing loss. It begins by defining different types of dizziness and vertigo, and describing the neuroanatomy of the vestibular system. It then discusses various causes of peripheral and central vertigo, methods for diagnosis including examining nystagmus and the head impulse test. Treatment involves addressing the underlying cause, with vestibular rehabilitation and symptomatic medications for attacks. The document also briefly covers syncope, defining it as loss of consciousness from decreased cerebral blood flow versus seizures, with neurally mediated reflex syncope being the most common cause.
Chorea refers to involuntary, irregular movements that flow between different body parts. It can affect the limbs, trunk, neck, face, and tongue. The intensity and frequency of chorea can vary significantly between individuals and over time. Chorea is often difficult to differentiate from other movement disorders like dystonia, myoclonus, tremor, and tics based on symptoms alone. The underlying cause and distribution of movements provides clues to the diagnosis. Hereditary forms of chorea like Huntington's disease are generally characterized by progressive worsening of motor and cognitive symptoms over time, while acquired forms may have a more variable course.
This document provides an overview of neuromuscular junction disorders with a focus on Myasthenia Gravis. It discusses the anatomy and physiology of the neuromuscular junction. It then outlines the approach to evaluating and diagnosing neuromuscular junction disorders including medical history, examination findings, and diagnostic testing. Specific details are provided on the immunopathology, subtypes, clinical presentation, physical findings, and treatment of Myasthenia Gravis. Treatment options discussed include cholinesterase inhibitors, immunotherapy, steroids, immunosuppressants, thymectomy, and crisis management. Considerations for pregnancy are also summarized.
This document discusses cranial nerve 7 (facial nerve). It describes the motor and sensory components of the nerve and their pathways in the brain and brainstem. It outlines how facial nerve lesions can cause different patterns of facial weakness depending on the location of the lesion. The clinical examination of facial nerve function is also summarized, including assessing muscle tone, symmetry of expression, eyelid position, and synkinesis.
This document discusses immune-mediated myopathies and provides details on muscle weakness patterns, diagnostic evaluations including autoantibodies, and features of specific conditions like dermatomyositis and antisynthetase syndrome. Muscle weakness in these conditions is typically symmetric, proximal, and involves shoulder and hip girdle muscles. Diagnostic tests include muscle enzymes, electrodiagnostic studies, muscle biopsy, and muscle MRI. Dermatomyositis is characterized by skin rashes and may be associated with cancers. Antisynthetase syndrome can cause myositis and interstitial lung disease and is associated with specific autoantibodies.
Ataxia is a physical finding characterized by gait imbalance and incoordination. It can be caused by diseases of the cerebellum or abnormal sensory input into the cerebellum. Common symptoms include difficulty walking, running, or with tasks requiring balance or coordination. Neurological examination focuses on eyes, speech, hands, legs, and gait. Brain imaging and family history help determine the cause, which can be genetic, acquired, or degenerative. Treatment involves addressing the underlying cause if possible with therapies like vitamins, diet changes, or immunotherapies. Symptomatic treatments help manage motor symptoms.
The document discusses various causes of dizziness including vertigo, presyncope, disequilibrium, and non-specific dizziness. Vertigo is characterized by illusions of motion and is commonly caused by peripheral vestibular disorders. Positional vertigo can be distinguished from presyncope by provoking dizziness with changes in head position rather than lowering blood pressure. Disequilibrium causes an unsteady feeling when walking and may result from neurological or musculoskeletal disorders. Non-specific dizziness is difficult for patients to describe and has a broad differential diagnosis. Evaluation of dizziness involves distinguishing these subtypes and identifying potential causes based on associated symptoms, physical exam findings, and test results.
The brain stem consists of the medulla, pons, and midbrain. It is situated in the posterior cranial fossa. The medulla is the lowest part and connects with the spinal cord. It contains nuclei for cranial nerves and tracts for sensory and motor functions. The pons is in the middle and connects the midbrain with the medulla. It contains pontine nuclei and transverse fibers. The midbrain connects the hindbrain and forebrain. It contains the cerebral peduncles and tectum including the superior and inferior colliculi.
Paraplegia can be flaccid or spastic depending on whether it is caused by a lower motor neuron or upper motor neuron lesion. Cerebral paraplegia results from lesions in the paracentral lobule and presents with bladder retention and cortical sensory loss. Spinal cord paraplegia can be compressive or non-compressive. Compressive paraplegia often shows a sensory level and root pain while non-compressive lesions may cause asymmetrical sensory loss. Differentiating intramedullary from extramedullary lesions considers features like root pain and bladder involvement. Causes of paraplegia include spinal cord tumors, infections, vascular lesions, and traumatic injuries or compressions.
1) The basal ganglia are a group of subcortical nuclei that play an important role in motor control and learning. Dysfunction of the basal ganglia can result in movement disorders.
2) Parkinson's disease is a common hypokinetic movement disorder caused by degeneration of dopaminergic neurons in the substantia nigra. Symptoms include tremors, rigidity, bradykinesia, and postural instability.
3) Essential tremor is characterized by a bilateral postural or action tremor of the hands and arms and has a strong genetic component. Sydenham chorea is an acquired chorea associated with rheumatic fever.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired disorders of coagulation. Virchow's triad describes the factors involved - venous stasis, endothelial injury, and hypercoagulability. Clinical features include leg pain and swelling. Diagnosis involves D-dimer testing, ultrasound, or venography. Treatment is anticoagulation with heparin or low molecular weight heparin followed by warfarin to prevent pulmonary embolism and post-thrombotic syndrome.
The case discussion involves a 42-year-old male presenting with a 2-year history of right-sided limb pain and discomfort, as well as progressive slowness, tremors, and gait instability over the past 8 months. On examination, the patient has hypophonic speech, difficulty articulating labials, a postural tremor of the right upper limb, cogwheel rigidity, decreased sensation on the right side, and impaired tandem gait. Investigations are notable for a normal MRI and CSF analysis. The discussion centers around possible diagnoses of Parkinson's disease versus atypical parkinsonisms and the anatomy and pathways of the basal ganglia motor loop.
This document provides an overview of hyperkinetic movement disorders, including their anatomy, etiology, pathophysiology, and specific types such as tremor, chorea, and myoclonus. It discusses essential tremor in detail, describing its prevalence, diagnostic criteria, clinical presentation including improvement with alcohol, and treatment options including medications, botulinum toxin injections, and deep brain stimulation. It also covers cortical and subcortical myoclonus, distinguishing between localized cortical versus more widespread cortical-subcortical forms.
The document summarizes diseases of the eye. It discusses diseases affecting different parts of the eye, including the orbit, lacrimal apparatus, eyelids, conjunctiva, cornea, sclera, uveal tract, lens, retina, optic nerve and glaucoma. Specific conditions covered include orbital cellulitis, blepharitis, conjunctivitis, trachoma, pterygium, neonatal conjunctivitis and vernal keratoconjunctivitis. Diagnostic features and treatment approaches are provided for many of the discussed diseases.
Vitamin A deficiency can cause night blindness, impaired vision, and even blindness. It is caused by poor intake of vitamin A rich foods, poor nutritional status, intestinal parasites like measles, and malabsorption disorders. Clinical features range from mild conjunctival dryness to corneal ulceration and melting. Treatment involves high dose vitamin A supplements based on age and severity of symptoms. Both short term treatment of symptomatic cases and long term prevention through improved nutrition, immunization, and control of diseases like measles and diarrhea are needed to control vitamin A deficiency.
- Ocular infection with Chlamydia Trachomatis is the leading cause of infectious blindness worldwide and the second leading cause of blindness overall.
- Trachoma is concentrated in hot, dusty, dry parts of the world where access to clean water and sanitation is limited. It presents as follicles and papillae on the conjunctiva that can lead to scarring, trichiasis, corneal opacity, and blindness if left untreated.
- The SAFE strategy, involving surgery, antibiotics, facial cleanliness, and environmental improvements is used to control trachoma. Oral azithromycin mass treatment is effective for reducing infection rates.
Retinoblastoma is a malignant tumor that arises from immature retinal cells, and is the most common intraocular malignancy in children. It can present unilaterally or bilaterally, and is caused by a mutation in the RB1 tumor suppressor gene. The goals of treatment are to save the patient's life, eye, and vision while minimizing complications. Treatment options depend on tumor size and include laser therapy, chemotherapy, brachytherapy, radiation therapy, or enucleation.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
2. • In neurologic patients, the speech abnormalities most often
encountered are dysarthria and aphasia.
• The essential difference is that
aphasia is a disorder of language function where as
dysarthria is a disorder of the motor production or
articulation of speech.
• The common vernacular phrase “slurred speech” could be
due to either.
• Aphasia usually affects other language functions such as
reading and writing.
• Dysarthria is defective articulation of sounds or words of
neurologic origin.
3. • In dysarthria, language functions are normal
and the patient speaks with proper syntax,
but pronunciation is faulty.
• And there are often other accompanying
bulbar abnormalities—such as dysphagia—
and a brainstem lesion is usually a prominent
clinical consideration.
4. • A commonly used classification separates
dysarthria into flaccid, spastic, ataxic,
hypokinetic, hyperkinetic, and mixed types.
5. • Lesions of the hypoglossal nerve or nucleus—or local
disorders of the tongue such as ankyloglossia—may
cause impairment of all enunciation, but with special
difficulty in pronouncing lingual sounds.
• The speech is lisping in character and is clumsy and
indistinct.
• Paralysis of the laryngeal musculature causes
hoarseness, and the patient may not be able to speak
above a whisper; there is particular difficulty
pronouncing vowels.
• Similar changes occur in laryngitis and in tumors of the
larynx.
6. • With unilateral laryngeal muscle weakness,
such as in recurrent laryngeal nerve lesions,
the voice is usually low-pitched and hoarse.
• However, occasionally severe unilateral vocal
cord weakness may be present without much
effect on speech because the normal vocal
cord is able to adduct across the midline and
approximate the abnormal cord.
7. • Hoarseness because of slight vocal cord weakness may
be brought out by having the patient talk with his head
turned to one side.
• With paralysis of the cricothyroid, the voice is hoarse
and deep and fatigues quickly.
• Diplophonia is one sound being produced at two
different frequencies because of differences in
vibration when one vocal cord is weak and the other
normal.
• In bilateral abductor paresis, speech is moderately
affected, but in bilateral total paralysis it is lost.
8. • Paralysis limited to the pharynx causes little detectable impairment
of articulation.
• Weakness of the soft palate results in nasal speech (rhinolalia, Gr.
lalia “speech”), caused by inability to seal off the nasal from the oral
cavity.
• Voice sounds have an added abnormal resonance.
• There is special difficulty with the velar sounds, but labials and
linguals are also affected because much of the air necessary for
their production escapes through the nose.
• The speech resembles that of a patient with a cleft palate.
• Characteristically, b becomes m, d becomes n, and k becomes ng.
Amyotrophic lateral sclerosis and MG are common causes of this
type of speech difficulty.
• Seventh nerve paralysis causes difficulty in pronouncing labials and
labiodentals.
9. • Dysarthria is noticeable only in peripheral facial palsy; the facial
• weakness in the central type of facial palsy is usually too mild to interfere
with
• articulation. Bell’s palsy occasionally causes marked dysarthria because of
• inability to close the mouth, purse the lips, and distend the cheeks. Similar
• articulatory defects are found in myopathies involving the labial muscles
(e.g.,
• facioscapulohumeral or oculopharyngeal dystrophy), in cleft lip and with
• wounds of the lips. There is little impairment of articulation in trigeminal
nerve
• lesions unless the involvement is bilateral; in such cases, there are usually
other
• characteristics of bulbar speech. Trismus may affect speech because the
patient
• is unable to open the mouth normally.
10. • Lower motor neuron disorders causing difficulty
in articulation may occur in cranial neuropathies.
• Lesions of the ninth and eleventh nerves usually
do not affect articulation.
• A unilateral lesion of CN X causes hypernasality.
• Lesions involving the vagus bilaterally distal to the
origin of the superior laryngeal nerve may leave
the vocal cords paralyzed in adduction, resulting
in a weak voice with stridor.
• With more proximal lesions, there is no stridor,
but the voice and cough are weak.
11. • Neuromuscular disorders, particularly
neuromuscular junction disorders, often interfere
with speech.
• In MG, prolonged speaking, such as counting,
may cause progressive weakness of the voice
with a decrease in volume and at times the
development of a bulbar or nasal quality, which
may even proceed to anarthria.
• As the voice fatigues, the speech of a patient with
bulbar myasthenia may be reduced to an
incoherent whisper.
12. • Motor neuron disease commonly causes
dysarthria.
• The type varies from a primarily flaccid dysarthria
in bulbar palsy to a primarily spastic dysarthria in
primary lateral sclerosis;
• most patients have classical amyotrophic lateral
sclerosis, and the dysarthria is of mixed type with
both flaccid and spastic components; that is,
there are both bulbar palsy and pseudobulbar
palsy.
13. • In bulbar palsy, dysarthria results from weakness
of the tongue, pharynx, larynx, soft palate, and,
to a lesser extent, the facial muscles, lips, and
muscles of mastication.
• Both articulation and phonation may be affected;
speech is slow and hesitant with failure of correct
enunciation, and all sounds and syllables may be
indistinct.
• The patient talks as though his mouth were full of
mashed potatoes.
14. • Speech is thick and slurred, often with a nasal quality and a
halting, drawling, monotonous character.
• The tongue lies in the mouth, more or less immobile,
shriveled, and fasciculating; the palate rises very little.
• The dysarthria may progress to a stage where there is
phonation but no articulation.
• Speech is reduced to unmodified, unintelligible laryngeal
noises.
• Often at this stage, the jaw hangs open and the patient
drools.
• The condition may eventually reach the stage of anarthria.
• Dysphagia is typically present as well.
15. • Supranuclear lesions involving the
corticobulbar pathways may also cause
dysarthria.
• Unilateral cortical lesions do not usually affect
speech unless they are in the dominant
hemisphere and cause aphasia.
16. • Bilateral supranuclear lesions involving the cortex, corona radiata, internal
• capsule, cerebral peduncles, pons, or upper medulla may cause
pseudobulbar palsy with spastic dysarthria.
• The muscles that govern articulation are both weak and spastic. Phonation
is typically strained-strangled, and articulation and
• diadochokinesis are slow.
• There is a thick bulbar type of speech, similar to that in progressive bulbar
palsy, but more explosive; it rarely progresses to complete anarthria.
• The tongue is protruded and moved from side to side with difficulty.
• There may also be spasticity of the muscles of mastication; mouth opening
is restricted and speech seems to come from the back of the mouth.
• The jaw jerk, gag reflex, and facial reflexes often become exaggerated and
emotional incontinence commonly occurs (pseudobulbar affect).
17. • Lesions of the basal ganglia may affect speech.
• Athetotic grimaces of the face and tongue may interfere with speech. Irregular spasmodic
contractions of the
• diaphragm and other respiratory muscles, together with spasms of the tongue and
• pharynx, may give the speech a curious jerky and groaning character. In
• addition, there may be a pseudobulbar element with slurred, indistinct, spastic
• speech. When chorea is present, the violent movements of the face, tongue, and
• respiratory muscles may make the speech jerky, irregular, and hesitant. The
• patient may be unable to maintain phonation, and occasionally, there is loss of
• the ability to speak. Dysarthria is one of the most common neurologic
• manifestations of Wilson’s disease, and frequently the presenting complaint. It is
• typically mixed with spastic, ataxic, hypokinetic, and dystonic elements. The
• type of dysarthria often corresponds with other manifestations, with spasmodic
• dysphonia in those with dystonic features, hypokinetic in those with
• parkinsonism, and ataxic in those with tremor as the primary manifestation.
• Pantothenate kinase-associated neurodegeneration (Hallervorden-Spatz
• syndrome) may cause a similar mixed spastic-extrapyramidal dysarthria.
18. • Speech in parkinsonism is often mumbled, hesitant, rapid, and soft (hypophonic).
• Parkinsonian patients tend to be soft, fast, mumbly talkers.
• There may sometimes be bradylalia, with feeble, slow, slurred speech because of
muscular rigidity and immobility of the lips and tongue.
• There is dysprosody, and the speech lacks inflections, accents, and modulation.
• The patient speaks in a monotone, and the words are slurred and run into one
another.
• The voice becomes increasingly weak as the patient talks, and he may become
unable to speak above a whisper; as the speech becomes more indistinct it may
become inaudible or practically disappear.
• Words may be chopped off.
• There may be sudden blocks and hesitations, or speech may stop abruptly.
• There may be pathologic repetition of syllables, words, or phrases (palilalia).
• Like the parkinsonian gait, the speech may show festination, with a tendency to
hurry toward the end of sentences or long words.
19. • Voice tremor produces rhythmic alterations in loudness and pitch. There may
• be associated tremor of the extremities or head, or other signs of neurologic
• dysfunction.
• Voice tremor may further complicate the other speech disturbances of
parkinsonism. Voice tremor occurs commonly in essential tremor, a frequently
• familial syndrome that most often affects the hands. Fine voice tremors are
• characteristic of essential tremor; coarse tremors are more commensurate with
• cerebellar disease. Essential voice tremor is probably more common than
• generally suspected, and many cases appear to go unrecognized or
• misdiagnosed, most often as spasmodic dysphonia. Voice tremor is a common
• manifestation of anxiety. Lip and chin tremors, when severe, may interfere with
• speech. In habit spasms, Tourette’s syndrome, and obsessive-compulsive states,
20. • there may be articulatory tics causing grunts, groans, or barking sounds. In
• Tourette’s syndrome, palilalia may also occur.
• Cerebellar dysfunction causes a defect of articulatory coordination (scanning
• speech, ataxic dysarthria, or speech asynergy). Many studies have attempted to
• localize speech functions in the cerebellum. The superior regions bilaterally
• appear to mediate speech motor control and the right cerebellar hemisphere has a
• putative role in speech planning and processing. Lesion mapping studies have
• shown that dysarthria occurs with pathology affecting the upper paravermal
• areas, or lobules V and VI. Subtypes of ataxic dysarthria are recognized,
• common to all is an impairment of articulation and prosody.
• Ataxic dysarthria causes a lack of smooth coordination of the tongue, lips,
• pharynx, and diaphragm. Ataxic speech is slow, slurred, irregular, labored, and
• jerky. Words are pronounced with irregular force and speed, with involuntary
• variations in loudness and pitch lending an explosive quality. There are
• unintentional pauses, which cause words and syllables to be erratically broken.
• Excessive separation of syllables and skipped sounds in words produce a
• disconnected, disjointed, faltering, staccato articulation (scanning speech). The
• speech pattern is reminiscent of a person who is sobbing or breathing hard from
• exertion. The unusual spacing of sounds with perceptible pauses between words
• and irregular accenting of syllables may cause a jerky, singsong cadence that
• resembles the reading of poetry. Ataxic speech is particularly characteristic of
• multiple sclerosis. It may be accompanied by grimaces and irregular respirations.
• Ataxia of the voice and scanning speech may be more apparent when the patient
• repeats a fairly long sentence.
21. • Specific speech abnormalities may occur in various
neurologic conditions.
• The disturbance varies in individual cases and depends
upon the site of the
• predominant pathologic change. In multiple sclerosis,
the speech is
• characteristically ataxic; there are explosive and
staccato elements, with
• slowness, stumbling, halting, slurring, and a cerebellar
type of speech ataxia.
• Spastic-ataxic and mixed dysarthrias are also common.
22. • In Friedreich’s ataxia, the
• ataxic, staccato, and explosive elements predominate. Speech is clumsy,
often
• scanning, and the pitch may suddenly change in the middle of a sentence.
In
• alcohol intoxication, the speech is slurred and indistinct. There is difficulty
with
• labials and linguals, and there may be tremulousness of the voice.
Conversation
• is often characterized by a tendency to garrulousness. The patient may
• repeatedly use words he can pronounce correctly, avoiding the use of
other
• words. This results from loss of cerebral cortical control over thought and
word
23. • formulation and speech, rather than from a primary articulatory
disturbance. In
• delirium tremens, the speech is tremulous and slurred. Other types of
• intoxication also produce speech that is thick and slurred. Rarely, the
inability to
• relax muscles in myotonia causes slight speech impairment. Myxedema
may
• cause a low-pitched, harsh, husky, slow, and monotonous voice. General
paresis
• may cause a tremulous, slurring type of dysarthria, with special difficulties
with
• the linguals and labials. Letters, syllables, and phrases are omitted or run
• together. The speech is slovenly, with ataxia, stumbling, and alliteration,
often
• accompanied by tremors of the lips, tongue, and face
24. • Spasmodic dysphonia is a focal dystonia characterized by a
striking
• abnormality of voice production. In adductor dysphonia,
irregular involuntary
• spasms of the vocal muscles cause erratic adduction of the
cords.
• As the patient strains to speak through the narrowed vocal
tract, his voice takes on a high-pitched, choked quality that
varies markedly during the course of a sentence.
• It is most marked in stressed vowels.
• The dysphonia may lessen or disappear when the patient
sighs or whispers.
25. • Stuttering refers to faulty, spasmodic,
interrupted speech characterized by
involuntary hesitations in which the speaker is
unable to produce the next expected sound.
• The flow of speech is broken by pauses during
which articulation is entirely arrested.
• Stammering may happen to anyone in certain
circumstances, as with embarrassment.
26. • Stuttering implies a more severe
• disturbance of speech, with faltering or
interrupted speech characterized by
• difficulty in enunciating syllables and joining
them together. Interference with
• communication may be profound and the social
consequences severe.
• Stuttering speech is stumbling and hesitant in
character, with habitual and spasmodic
repetitions of consonants or syllables, alternating
with pauses.
27. • There may be
• localized cramps, spasms, and tic-like contractions of the muscles essential to
• articulation, which may be accompanied by grimaces, spasms and contractions
• of the muscles of the head and extremities, and spasm and incoordination of the
• respiratory muscles. The individual may be unable to pronounce certain
• consonants, with particular difficulty in using dentals and labials. Often the first
• syllable or consonant of a word is repeated many times. The individual may
• remain with his mouth open until the articulatory spasm relaxes, then the words
• explode out until the breath is gone. He then takes another breath, and the
• process is repeated. Stuttering is markedly influenced by emotional excitement
• and by the presence of strangers. In spite of difficulty in speaking, the individual
• may be able to sing without hesitation. There have been accomplished
• professional singers who stuttered severely in ordinary speech. Britain’s King
• George VI stuttered severely, as memorably depicted in the motion picture The
• King’s Speech. Many theories have been offered regarding the etiology of
• stuttering.
28. • In lalling (lallation, “baby talk”), the speech is childish, babbling, and
• characterized by a lack of precision in pronouncing certain consonants,
• especially the letters r and l. A uvular is substituted for a lingual-palatal r, so that
• “broken reed” is pronounced “bwoken weed.” The diphthong ow or other sounds
• may be substituted for the l sound, or sometimes l may be substituted for r. T and
• d may be substituted for s, g, and the k sound. Lalling may occur because of
• hearing defects, mental or physical retardation, or from psychogenic disorders.
• In lisping, the sibilants are imperfectly pronounced, and th is substituted for s; a
• similar defect in articulation may be associated with partial edentulism. Lalling
• and lisping are usually because of imperfect action of the articulatory apparatus
• (as in children), persistent faulty habits of articulation, imitation of faulty
• patterns of articulation, poor speech training, habit, or affectation.
29. • NONORGANIC (FUNCTIONAL) SPEECH
• DISORDERS
• Emotional and psychogenic factors influence articulation. Speech, but not
• language, disorders may occur on a nonorganic basis. Nonorganic voice
• disorders can take many different forms and can be caused by a variety of
• factors. The most common functional voice disorders are dysphonia and
• aphonia. Dysarthria, lalling, stuttering, mutism, or anarthria occurs rarely.
• Psychogenic foreign accent syndrome has been reported. There may be infantile
• language wherein the objective pronoun is used as the subject (e.g., “Me want to
• go home”). Onset is often abrupt, perhaps in association with emotional trauma;
• there may be periods of remission, and the condition may suddenly disappear.
• The speech defect may vary in type from time to time. It is often bizarre, and
• does not correspond to any organic pattern. The patient may fail to articulate and
• speak only by whispering. Speech may be lost but the patient is able to sing,
• whistle, and cough.
30. • There may be associated dysphagia and globus hystericus.
• In anxiety and agitation the speech may be broken, tremulous, high-pitched,
• uneven, and breathless. Stuttering and stammering are common. The speech may
• be rapid and jumbled (tachyphemia or tachylalia), or there may be lalling or
• mutism. In hysterical aphonia, there is profound speech difficulty but no
• disturbance of coughing or respiration. Manic patients may have a rapid flow of
• words (pressured speech), often with an abrupt change of subject. In depression
• speech may be slow, sometimes with mutism. True organic aphasia is
• occasionally confused with hysterical or simulated mutism. The aphasic patient,
• no matter how speechless, at least occasionally tries to speak; in hysterical
• mutism there may be the appearance of great effort without the production of so
• much as a tone; in simulated mutism, the patient does not even make an effort.
• Mutism may also occur in catatonia. In schizophrenia there may be hesitancy
• with blocking, or negativism with resulting mutism (alalia). Two common
• nonorganic dysphonias seen in children and adolescents are the whispering
• syndrome, seen primarily in girls, and mutational falsetto (hysterical high-
• pitched voice), seen primarily in boys.
31. • Palilalia, echolalia, and perseveration are often manifestations of psychosis, but
they can occur with organic lesions, especially of the frontal lobes.
• Palilalia is the repetition of one’s own speech.
• Echolalia is the meaningless repetition of heard words.
• Perseveration is the persistence of one reply or one idea in response to various
questions.
• Neologisms are new words, usually meaningless, coined by the patient, and
usually heard in psychotic states or in aphasic patients.
• Idioglossia is imperfect articulation with utterance of meaningless sounds; the
• individual may speak with a vocabulary all his own. Idioglossia may be
• observed in patients with partial deafness, aphasia, and congenital word
• deafness. Alliterative sentences, repetition, and confusion are found in delirium
• and in psychosis. Dyslogia refers to abnormal speech because of mental disease,
• and it is most often used to refer to abnormal speech in dementia.
32. APHASIA/DYSPHASIA
• It refers to a disorder of language, including
various combinations of impairment in the
ability to spontaneously produce, understand,
and repeat speech, as well as defects in the
ability to read and write.
• A simple definition of aphasia is a disorder of
previously intact language abilities because of
brain damage.
33. Cont….
• A more comprehensive definition considers it a
defect in or loss of the power of expression by
speech, writing, or gestures or a defect in or loss
of the ability to comprehend spoken or written
language or to interpret gestures, because of
brain damage.
• Aphasia implies that the language disorder is not
due to paralysis or disability of the organs of
speech or of muscles governing other forms of
expression.
34. • Cerebral dominance and handedness are at least
in part hereditary.
• Failure to develop clear hemispheric dominance
has been offered as an explanation for such
things as dyslexia, stuttering, mirror writing,
learning disability, and general clumsiness.
• Many patients are at least to some degree
ambidextrous, and it may be difficult, short of a
Wada test, to be certain which hemisphere is
language dominant.
35. Cont….
• Various “foolproof” markers of true
handedness have been proposed, but all are
suspect.
• In right-handed patients, aphasia will be due
to a left hemisphere lesion in 99% of the
cases; the other 1% are crossed aphasics.
• In left-handers, the situation is much more
variable.
36. From up-to-date
Fluency
• Fluency is usually assessed qualitatively by listening to the
patient's spontaneous speech.
• Nonfluent speech has the following characteristics:
Sparse output, with a decreased number of words per
minute.
Shortened phrases, typically five words or less.
Agrammatism, characterized by the omission or
substitution of function words (e.g., prepositions, articles,
conjunctions) or suffixes (e.g., "ed" for past events).
• This type of speech pattern is the most specific feature of
dysfluency and often referred to as "telegraphic".
37. Effortfulness, with hesitations and a disruption
of the normal melodic rhythm.
• Occasionally, patients with normal speech
melody and little effort in spontaneous speech
will exhibit word-finding pauses that make the
assessment of fluency more difficult; however,
these patients should be classified as fluent.
38. A breakdown of speech praxis, the ability to
coordinate the articulatory movements required
for comprehensible speech.
• This may be tested by asking the patient to
repeatedly pronounce the syllables, /pa/, /ta/,
and /ka/ (individually) and then to link the three
together into a sequence /pa-ta-ka/.
• Another approach is to ask the patient to repeat
the word 'catastrophe' or 'artillery' as many times
as possible in five or ten seconds.
39. Content
• Language errors during spontaneous or tested speech
should be noted.
• Patients with Wernicke's aphasia, for example, make
paraphasic errors and neologisms.
• Paraphasic errors are usually either whole word
(semantic) substitutions, eg, "chair" for "table," or
phonemic (literal) substitutions, eg, "cable" for "table."
• Neologisms are entirely new nonwords.
• Patients are often unaware of their paraphasic errors.
40. Naming
• When testing naming, patients are asked to give the
names of real objects available to the examiner, such as
"key," "buttonhole," "eyebrow," and "knuckles."
• Words used less frequently are more difficult for the
aphasic patient to retrieve and constitute a more
sensitive test for anomia.
• Photographs or line drawings may also be used to
assess anomia.
• The retrieval of verbs is generally best tested by using
pictures.
41. Comprehension
• Comprehension is evaluated by giving a sequence
of commands, beginning with one-step, midline
commands ("Close your eyes," or "Stick out your
tongue"),
• and progressing to multi-step commands and
those involving the extremities ("Show me two
fingers," "Close your eyes and point to the
window," "Stand up, turn around, clap two times,
and sit down").
42. • Commands that require a body part to cross
the midline (eg, "Touch your right ear with
your left thumb") are more complex than
those that do not.
• Commands involving increasingly complex
grammatical structures can also be used
• (eg, "Touch the coin with the pencil"; "With
the comb, touch the coin").
43. • More complex questions:
• "Does a stone sink in water?"
• "Do you put on your shoes before your
socks?") and those using complex grammatical
structures such as passive voice or possessive
(eg, "Is my aunt's uncle a man or a woman?"
• "If a lion was killed by a tiger, which one is still
alive?") can elicit comprehension deficits in
those who can follow simple commands.
44. Reading
• Patients are asked to read aloud from a
newspaper or from a list of single words.
• There may be dissociations in the ability to read
regularly spelled words, irregular words, or
pronounceable nonwords.
• Reading comprehension may be tested with
written commands (eg, "Fold this paper in half
and put it on the table") or with a written word-
picture matching test.
45. Writing
• The patient is asked to write a sentence
spontaneously.
• It may also be useful to dictate material to the
patient, particularly for testing of regularly
spelled words, irregular words, and
pronounceable nonwords.
• The patient can also be asked to write names of
objects or actions in response to pictures.
• Accuracy with written naming may be dissociated
from spoken naming
46.
47. CLASSIFICATION OF THE APHASIAS
• Classification of the aphasias is problematic.
• A strictly anatomic classification does not apply in
all instances,
• for a small lesion may cause severe impairment
of both fluency and comprehension,
• whereas an extensive lesion sometimes causes an
isolated defect.
• Lesions similar in size and location on imaging
studies may be associated with different aphasic
syndromes and vice-versa.
49. Cont….
• The Wernicke-Geschwind model (Boston classification)
recognizes eight aphasia syndromes:
Broca’s
Wernicke’s
conduction
global
transcortical motor
transcortical sensory
transcortical mixed (isolation of the speech area), and
anomic.
50. Cont….
• Shifted sinistrals (anomalous dextrals) are
naturally left-handed individuals forced by
parents or teachers early in life to function
right-handed, primarily for writing.
• This approach to dealing with left-handedness
has largely died out, but shifted sinistrals are
still encountered, primarily in the older
population.
51. Cont….
• One can therefore encounter:
right-handed patients (dextrals) who are left-
hemisphere dominant for language,
left-handed patients (sinistrals) who are still left-
hemisphere dominant,
“right-handed” patients who are right-
hemisphere dominant (anomalous dextrals), and
left-handed patients who are right-hemisphere
dominant (true sinistrals).
52. The Major Aphasia Syndromes
Fluency Compreh
ension
Repetiti
on
Naming Reading Writing Localization
Broca’s
Wernicke’s
Global
Conduction
Anomic
Transcortical,
motor
Transcortical,
sensory
Transcortical,
mixed
Verbal Apraxia
53. Types of dysarthria
• It is problem with articulation of speech; language
function is intact.
• Flaccid dysarthria: breathy, nasal voice, imprecise
consonants.
• It reflects LMN weakness of the bulbar muscle
• E.g. Myasthenia gravis
• Spastic dysarthria: Strain-strangle harsh voice ,slow rate
imprecise consonants e.g.‘’Papapa’’ sounds like
‘’Bababa’’
• Associated with bilateral UMN lesions.
54. Cont….
• Ataxic dysarthria: Irregular articulatory breakdowns
scanning speech
• Associated with cerebellar disorders.
• Hypokinetic dysarthria: rapid rate, reduced
loudness,monopitch and monoloudness
• Typical speech pattern in Parkinson's disease
• Hyperkinetic dysarthria: Prolonged phonemes, variable
rates, in appropriate silences, voice stoppages
• E.g. Huntington disease and dystonia
55. Cont….
• Ataxic dysarthria: Irregular articulatory breakdowns
scanning speech
• Associated with cerebellar disorders.
• Hypokinetic dysarthria: rapid rate, reduced
loudness,monopitch and monoloudness
• Typical speech pattern in Parkinson's disease
• Hyperkinetic dysarthria: Prolonged phonemes, variable
rates, in appropriate silences, voice stoppages
• E.g. Huntington disease and dystonia
Editor's Notes
In expressive aphasia, the patient has difficulty with speech output and struggles to talk (nonfluent);
in receptive aphasia, the primary difficulty is with understanding language, whereas speech output is unaffected (fluent).